2024
Availability of Medications for Opioid Use Disorder in US Psychiatric Hospitals
Cohen S, Beetham T, Fiellin D, Muvvala S. Availability of Medications for Opioid Use Disorder in US Psychiatric Hospitals. JAMA Network Open 2024, 7: e2444679. PMID: 39535800, PMCID: PMC11561693, DOI: 10.1001/jamanetworkopen.2024.44679.Peer-Reviewed Original ResearchPrenatal opioid exposure significantly impacts placental protein kinase C (PKC) and drug transporters, leading to drug resistance and neonatal opioid withdrawal syndrome
Radhakrishna U, Radhakrishnan R, Uppala L, Muvvala S, Prajapati J, Rawal R, Bahado-Singh R, Sadhasivam S. Prenatal opioid exposure significantly impacts placental protein kinase C (PKC) and drug transporters, leading to drug resistance and neonatal opioid withdrawal syndrome. Frontiers In Neuroscience 2024, 18: 1442915. PMID: 39238930, PMCID: PMC11376091, DOI: 10.3389/fnins.2024.1442915.Peer-Reviewed Original ResearchNeonatal opioid withdrawal syndromeNeonatal opioid withdrawal syndrome treatmentRegulation of drug transportersOpioid use disorderOpioid withdrawal syndromeProtein kinase CDrug transportATP-binding cassetteDrug resistanceWithdrawal syndromeSevere neonatal opioid withdrawal syndromeSolute carrierPrenatal opioid exposureOpioid-exposed infantsATP-binding cassette drug transportersLevels of ATP-binding cassetteIllumina Infinium MethylationEPIC arrayKinase CMethylation changesGastric acid secretionImprove treatment outcomesDrug-drug interactionsMaternal opioidsMaternal relapseInfinium MethylationEPIC arrayThe Impact of High-Potency Synthetic Opioids on Pharmacotherapies for Opioid Use Disorder: A Scoping Review
Jegede O, De Aquino J, Hsaio C, Caldwell E, Funaro M, Petrakis I, Muvvala S. The Impact of High-Potency Synthetic Opioids on Pharmacotherapies for Opioid Use Disorder: A Scoping Review. Journal Of Addiction Medicine 2024, 18: 499-510. PMID: 39356620, PMCID: PMC11449257, DOI: 10.1097/adm.0000000000001356.Peer-Reviewed Original ResearchNonmedical opioid useOpioid use disorderOpioid useWithdrawal symptomsTreatment outcomesSymptoms prior to treatmentUse disorderRisk of precipitated withdrawalLow-dose buprenorphineSynthetic opioidsPotency synthetic opioidsConclusions Current evidencePrecipitated withdrawalRisk of overdoseDosing strategiesPharmacological interactionsClinical significanceDecreased riskWeb of ScienceOpioidInclusion criteriaCurrent evidenceClinical implicationsMOUDPainPlacental cytochrome P450 methylomes in infants exposed to prenatal opioids: exploring the effects of neonatal opioid withdrawal syndrome on health horizons
Radhakrishna U, Sadhasivam S, Radhakrishnan R, Forray A, Muvvala S, Metpally R, Patel S, Rawal R, Vishweswaraiah S, Bahado-Singh R, Nath S. Placental cytochrome P450 methylomes in infants exposed to prenatal opioids: exploring the effects of neonatal opioid withdrawal syndrome on health horizons. Frontiers In Genetics 2024, 14: 1292148. PMID: 38264209, PMCID: PMC10805101, DOI: 10.3389/fgene.2023.1292148.Peer-Reviewed Original ResearchNeonatal opioid withdrawal syndromeOpioid withdrawal syndromePlacental tissueWithdrawal syndromeLong-term clinical implicationsPrenatal opioid exposureNOWS treatmentPrenatal opioidsOpioid exposureOpioid effectsOpioid usePharmacologic treatmentCYP genesControl mothersMultiple CYP genesValuable biomarkerClinical implicationsInfantsPersonalized treatmentOpioidsCytochrome P450 enzymesInfinium MethylationEPIC BeadChipTreatmentIllumina Infinium MethylationEPIC BeadChipSyndrome
2023
Long-Term Treatment of Opioid Use Disorder with Medications
Wolfgang A, Weimer M, Na P, Fiellin D, Muvvala S. Long-Term Treatment of Opioid Use Disorder with Medications. 2023, 631-661. DOI: 10.1093/oxfordhb/9780197618431.013.23.ChaptersOpioid use disorderMedical diseasesUse disordersChronic medical diseasesExtended-release naltrexoneLong-term treatmentCause mortalityOUD treatmentClinical outcomesOngoing treatmentOpioid overdoseTerm treatmentMedicationsPsychosocial outcomesAddiction treatmentDisease paradigmOutcomesTreatmentEvidence-based paradigmDiseaseDisordersNegative outcomesImproved retentionRemissionRelapsingThe Current Status of Medical Student Education on Opioids
Jegede O, Na P, Petrakis I, Muvvala S. The Current Status of Medical Student Education on Opioids. 2023, 121-138. DOI: 10.1093/oxfordhb/9780197618431.013.5.Peer-Reviewed Original ResearchFacilitation and Preferred Models for Delivering Substance Use Disorder Treatment in HIV Clinics: Results From a Multisite Randomized Trial
Muvvala S, Gan G, Morford K, Dziura J, Esserman D, Porter E, Chan P, Cornman D, Reynolds J, Yager J, Fiellin D, Edelman E. Facilitation and Preferred Models for Delivering Substance Use Disorder Treatment in HIV Clinics: Results From a Multisite Randomized Trial. Journal Of Addiction Medicine 2023, 17: e388-e391. PMID: 37934538, PMCID: PMC10726383, DOI: 10.1097/adm.0000000000001192.Peer-Reviewed Original ResearchConceptsOpioid use disorderAlcohol use disorderTobacco use disorderHIV clinicUse disordersAddiction treatmentSubstance use disorder treatmentUse disorder treatmentMaintenance phaseRandomized trialsStaff preferencesImproved outcomesMultisite Randomized TrialImplementation facilitationDisorder treatmentControl phaseClinicCliniciansTreatment modelTreatmentDisordersSignificant differencesInterventionHigher proportionAddiction treatment modelsPlacental microRNA methylome signatures may serve as biomarkers and therapeutic targets for prenatally opioid-exposed infants with neonatal opioid withdrawal syndrome
Radhakrishna U, Nath S, Uppala L, Veerappa A, Forray A, Muvvala S, Metpally R, Crist R, Berrettini W, Mausi L, Vishweswaraiah S, Bahado-Singh R. Placental microRNA methylome signatures may serve as biomarkers and therapeutic targets for prenatally opioid-exposed infants with neonatal opioid withdrawal syndrome. Frontiers In Genetics 2023, 14: 1215472. PMID: 37434949, PMCID: PMC10332887, DOI: 10.3389/fgene.2023.1215472.Peer-Reviewed Original Research
2022
Effect of Implementation Facilitation to Promote Adoption of Medications for Addiction Treatment in US HIV Clinics
Edelman EJ, Gan G, Dziura J, Esserman D, Porter E, Becker WC, Chan PA, Cornman DH, Helfrich CD, Reynolds J, Yager JE, Morford KL, Muvvala SB, Fiellin DA. Effect of Implementation Facilitation to Promote Adoption of Medications for Addiction Treatment in US HIV Clinics. JAMA Network Open 2022, 5: e2236904. PMID: 36251291, PMCID: PMC9577676, DOI: 10.1001/jamanetworkopen.2022.36904.Peer-Reviewed Original ResearchConceptsTobacco use disorderHIV clinicOpioid use disorderUse disordersAlcohol use disorderAddiction treatmentControl periodImplementation facilitationAdoption of medicationsMulticomponent implementation strategyProvision of MOUDUS HIV clinicsMaintenance periodElectronic health record dataHealth record dataEvaluation periodAdult patientsMean ageClinical trialsMAIN OUTCOMEClinicMOUDPatientsDisordersPatient incentivesIntegrating Ambulatory Addiction Consultation Service Into a Community Mental Health Center
Jegede O, Muvvala S, Cahill J, Wade R, Jordan A. Integrating Ambulatory Addiction Consultation Service Into a Community Mental Health Center. Journal Of Addiction Medicine 2022, 17: 126-128. PMID: 36111994, DOI: 10.1097/adm.0000000000001081.Peer-Reviewed Original ResearchConceptsCommunity mental health centerAddiction consult serviceMental health centersHealth centersConsult serviceConsultation serviceModel of careEvidence-based treatmentsAcute settingAmbulatory settingAddiction treatmentCareAmbulatory systemDrugsAddiction professionalsTreatmentPatientsReplicable modelSettingPatients' perspectives of medications for addiction treatment in HIV clinics: A qualitative study
Morford KL, Muvvala SB, Chan PA, Cornman DH, Doernberg M, Porter E, Virata M, Yager JE, Fiellin DA, Edelman EJ. Patients' perspectives of medications for addiction treatment in HIV clinics: A qualitative study. Journal Of Substance Use And Addiction Treatment 2022, 139: 108767. PMID: 35341613, PMCID: PMC9187601, DOI: 10.1016/j.jsat.2022.108767.Peer-Reviewed Original ResearchConceptsSubstance use disordersHIV clinicAddiction treatmentSubstance useEvidence-based medicationsMedication treatment optionsMedication side effectsHealth Services frameworkFocus groupsHIV cliniciansTreatment optionsMultidisciplinary screeningChronic diseasesPatient educationPatient's perspectivePromoting ActionStudy populationDisorder careSide effectsUse disordersPatient receptivityQualitative studyOverall healthClinicKnowledge deficits
2021
Maternal opioid use disorder: Placental transcriptome analysis for neonatal opioid withdrawal syndrome
Radhakrishna U, Nath SK, Vishweswaraiah S, Uppala LV, Forray A, Muvvala SB, Mishra NK, Southekal S, Guda C, Govindamangalam H, Vargas D, Gardella WG, Crist RC, Berrettini WH, Metpally RP, Bahado-Singh RO. Maternal opioid use disorder: Placental transcriptome analysis for neonatal opioid withdrawal syndrome. Genomics 2021, 113: 3610-3617. PMID: 34352367, DOI: 10.1016/j.ygeno.2021.08.001.Peer-Reviewed Original ResearchConceptsNeonatal opioid withdrawal syndromeOpioid withdrawal syndromeWithdrawal syndromePrenatal opioid exposureOpioid use disorderPlacentas of infantsPlacental tissue samplesP-valueIngenuity Pathway AnalysisOpioid exposureUse disordersUnexposed controlsFDR p-valueGenes CYP1A1Tissue samplesSyndromePathway analysisCYP1A1NewbornsInfantsEtiologyApoBPlacentaGenesGRIN2AReadiness to Provide Medications for Addiction Treatment in HIV Clinics: A Multisite Mixed-Methods Formative Evaluation
Edelman EJ, Gan G, Dziura J, Esserman D, Morford KL, Porter E, Chan PA, Cornman DH, Oldfield BJ, Yager JE, Muvvala SB, Fiellin DA. Readiness to Provide Medications for Addiction Treatment in HIV Clinics: A Multisite Mixed-Methods Formative Evaluation. JAIDS Journal Of Acquired Immune Deficiency Syndromes 2021, 87: 959-970. PMID: 33675619, PMCID: PMC8192340, DOI: 10.1097/qai.0000000000002666.Peer-Reviewed Original ResearchConceptsHIV clinicTreatment medicationsMixed-methods formative evaluationAddiction treatmentTreatment-eligible patientsSubscale scoresAddiction treatment medicationsAdverse health consequencesHIV careMedication complexityTobacco useMedicationsClinicHealth consequencesSite specialistMultidisciplinary teamworkBehavioral servicesTreatment modelOpioidsLocal championsVariable experienceInconsistent availabilityAddiction treatment modelsFocus groupsTreatmentThe effect of varenicline on smoking and drinking outcomes among Black and White adults with alcohol use disorder and co-occurring cigarette smoking: A secondary analysis of two clinical trials
Haeny AM, Gueorguieva R, Montgomery L, Bold KW, Fucito LM, Wu R, Muvvala SB, Zweben A, O'Malley SS. The effect of varenicline on smoking and drinking outcomes among Black and White adults with alcohol use disorder and co-occurring cigarette smoking: A secondary analysis of two clinical trials. Addictive Behaviors 2021, 122: 106970. PMID: 34216871, PMCID: PMC9426655, DOI: 10.1016/j.addbeh.2021.106970.Peer-Reviewed Original ResearchConceptsEffects of vareniclineAlcohol use disorderCigarette smokingClinical trialsUse disordersWhite adultsEfficacy of vareniclineNumber of drinksVareniclineSmokingPrimary analysisAlcohol treatmentSecondary analysisAlcohol useTrialsBlack participantsDrinking outcomesLinear mixed modelsAdultsWhite peopleWhite participantsMixed modelingCigarettesDisordersTreatmentPlacental DNA methylation profiles in opioid-exposed pregnancies and associations with the neonatal opioid withdrawal syndrome
Radhakrishna U, Vishweswaraiah S, Uppala LV, Szymanska M, Macknis J, Kumar S, Saleem-Rasheed F, Aydas B, Forray A, Muvvala SB, Mishra NK, Guda C, Carey DJ, Metpally RP, Crist RC, Berrettini WH, Bahado-Singh RO. Placental DNA methylation profiles in opioid-exposed pregnancies and associations with the neonatal opioid withdrawal syndrome. Genomics 2021, 113: 1127-1135. PMID: 33711455, DOI: 10.1016/j.ygeno.2021.03.006.Peer-Reviewed Original ResearchConceptsNeonatal opioid withdrawal syndromeOpioid withdrawal syndromeIngenuity Pathway AnalysisWithdrawal syndromeOpioid-exposed pregnanciesPlacental tissue samplesOpioid abusePlacental tissueTissue samplesPregnancyMethylation dysregulationGenome-wide methylation analysisSyndromeInfantsPathway analysisAUCDNA methylation profilesMethylation profilesGroupPathophysiologyTherapyStrong evidence
2020
Stitching A Solution to the Addiction Epidemic: A Longitudinal Addiction Curricular Thread across Four Years of Medical Training
Muvvala SB, Schwartz ML, Petrakis I, O'Connor P, Tetrault JM. Stitching A Solution to the Addiction Epidemic: A Longitudinal Addiction Curricular Thread across Four Years of Medical Training. Substance Use & Addiction Journal 2020, 41: 475-479. PMID: 31951809, DOI: 10.1080/08897077.2019.1709606.Peer-Reviewed Original ResearchConceptsCurricular threadPractice-based learning activitiesMedical school curriculumComprehensive needs assessmentCurriculum goalsLearning activitiesSchool curriculumCurriculum developmentClerkship directorsDidactic activitiesEducational strategiesMedical schoolsKern modelClinical simulationMedical trainingCurriculumWorkshop exercisesNeeds assessmentWork forceClinical experienceSchoolsEducationPublic health impactImplementationInstitutionsWorking with HIV clinics to adopt addiction treatment using implementation facilitation (WHAT-IF?): Rationale and design for a hybrid type 3 effectiveness-implementation study
Edelman EJ, Dziura J, Esserman D, Porter E, Becker WC, Chan PA, Cornman DH, Rebick G, Yager J, Morford K, Muvvala SB, Fiellin DA. Working with HIV clinics to adopt addiction treatment using implementation facilitation (WHAT-IF?): Rationale and design for a hybrid type 3 effectiveness-implementation study. Contemporary Clinical Trials 2020, 98: 106156. PMID: 32976995, PMCID: PMC7511156, DOI: 10.1016/j.cct.2020.106156.Peer-Reviewed Original ResearchConceptsHIV clinicImplementation facilitationAddiction treatmentHealth services research frameworkHybrid type 3Effectiveness-implementation studyEvidence-based counselingSubstantial morbidityClinical outcomesOpioid misusePromoting ActionEffectiveness outcomesClinicFacilitators of integrationType 3Implementation outcomesTreatmentOutcomesWedge designHIVResearch implementationStudy goalFacilitation studiesStaff readinessMedicationsMultiple Psychiatric Morbidity and Continued Use of Naltrexone for Alcohol Use Disorder
Muvvala SB, O'Malley SS, Rosenheck R. Multiple Psychiatric Morbidity and Continued Use of Naltrexone for Alcohol Use Disorder. American Journal On Addictions 2020, 30: 55-64. PMID: 32805083, DOI: 10.1111/ajad.13089.Peer-Reviewed Original ResearchMeSH KeywordsAdultAgedAlcohol DeterrentsAlcoholismAmbulatory CareDepressive Disorder, MajorFemaleHospitalizationHumansIll-Housed PersonsMaleMental Health ServicesMiddle AgedMorbidityNaltrexonePsychotherapyPsychotropic DrugsSchizophreniaSocioeconomic FactorsUnited StatesUnited States Department of Veterans AffairsVeteransConceptsAlcohol use disorderUse of naltrexonePsychotropic prescription fillsPrescription fillsUse disordersOutpatient mental health servicesCorrelates of initiationMedical-surgical hospitalizationMultiple psychiatric morbiditiesEfficacy of naltrexonePsychotropic medication useVeterans Health AdministrationPsychiatric outpatient servicesConcurrent psychiatric disordersMajor depressive disorderMental health servicesProportion of veteransNaltrexone initiationMedication usePsychiatric morbidityDepressive disorderImportant patientPsychiatric hospitalizationMultinomial logistic regressionOutpatient servicesPerceived barriers to access care, anticipated discrimination and structural vulnerability among African Americans with substance use disorders
Jegede O, Muvvala S, Katehis E, Paul S, Soipe A, Jolayemi A. Perceived barriers to access care, anticipated discrimination and structural vulnerability among African Americans with substance use disorders. International Journal Of Social Psychiatry 2020, 67: 136-143. PMID: 32666877, DOI: 10.1177/0020764020934512.Peer-Reviewed Original ResearchConceptsSubstance use disordersStigma subscalesUse disordersPsychiatric diagnosisAfrican AmericansAfrican American patientsTreatment-related stigmaAnticipated discriminationSubstance use servicesTotal mean scoreAmerican patientsTeaching hospitalCare EvaluationMental illnessHealth disparitiesHealth inequitiesMean scoreSignificant differencesDiagnosisAssessment toolCareDisordersStigmaSubscalesDiscrimination SurveyEffects of Alcohol Cue Reactivity on Subsequent Treatment Outcomes Among Treatment‐Seeking Individuals with Alcohol Use Disorder: A Multisite Randomized, Double‐Blind, Placebo‐Controlled Clinical Trial of Varenicline
Miranda R, O’Malley S, Padovano H, Wu R, Falk DE, Ryan ML, Fertig JB, Chun TH, Muvvala SB, Litten RZ. Effects of Alcohol Cue Reactivity on Subsequent Treatment Outcomes Among Treatment‐Seeking Individuals with Alcohol Use Disorder: A Multisite Randomized, Double‐Blind, Placebo‐Controlled Clinical Trial of Varenicline. Alcohol Clinical And Experimental Research 2020, 44: 1431-1443. PMID: 32363592, PMCID: PMC7572549, DOI: 10.1111/acer.14352.Peer-Reviewed Original ResearchConceptsAlcohol use disorderEffects of vareniclineAlcohol cue reactivityClinical trialsCue-reactivity paradigmAlcohol useCue reactivityUse disordersHuman laboratoryAlcohol cue-induced cravingSubsequent treatment outcomesΑ4β2 nicotinic acetylcholine receptorsCue-induced alcoholAlcohol cue reactivity paradigmCue-induced cravingNicotinic acetylcholine receptorsHeavy alcohol useCue-elicited cravingHuman laboratory paradigmTreatment outcomesVareniclinePlaceboProspective associationsAlcohol cravingAcetylcholine receptors